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GENERAL INFORMATION

BusinessName

InternalCode

Economic Activity/Line of Business

Evaluated Activity

Evaluation Type OWN COMPANY

Main Office Address

Location

Phone

Fax

Web Page Does not have

Nº de Empleados Fixed
Subcontracted

Antiquity of the Company 0Years

Questionnaire Services/Contractors

Business Contact Name

Telephone

Email

Cell Phone

Purpose Homologate the company

From the aspects of: AdditionalInformation; Obligations

Legal; Operational Capacity; Quality Management; Safety,
H e a l t h a n d E n v i r o n m e n t ; C o m m e r c i a l M a n a g e m e n t . Wi t h t h e r e q u i r e m e n t s
defined by the company
SGS OF PERU SAC

Background This evaluation has been carried out on behalf of:

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SGS OF PERU SAC

accordingtotheproceduresofSGSDELPERUSACforthe
Supplier Standardization Service. It consists of the
collection of information and its subsequent evaluation,
agreementtotherequirementsofthecompany:
SGS OF PERU SAC
Consider more important for your procurement management

Conditions of Issue Evaluation weighting of Legal Obligations; Capacity

Operations; Quality Management; Safety, Health and Environment;
Commercial Management; previously specified by the company
SGS OF PERU SAC
ThepresentHomologationReportisvalidforoneyearfrom
From the date of issue, the scope cannot be extended to
other activities than those mentioned above. The recorded data
Inthepresentreportwe
, reflectourfindings.
the responsibility of our company extends to guaranteeing
only that the supplier has been evaluated and rated as
[Link]
SACno assumes no responsibility if the supplier fails.
any product or service that was the subject of homologation.

Observation in constancy

Conclusions

Inspector Name

DateofReceiptofthe
Documentation

FechadeVisita(*)

Issued on

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ADDITIONAL INFORMATION

ADDITIONAL INFORMATION

AffiliatedCompanies(controlledbythesamepartners)

Name Activity

[Link]

3. Main Shareholders or Partners

Name %Actual

4. Main Executives / Managers

Name Cargo

5. Electronic / Registral Registration

6. Amendment of Bylaws / Powers in Effect

Agreements with other firms

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LEGAL OBLIGATIONS

FINANCIAL STATEMENTS

8. Financial Statements
If the company enters the homologation process between January and June, it must present the financial statements.
asofDecember31ofthepreviousyear.
The company enters the homologation process between July and December, it must present the states.
financial as of June 30 of the same year.
Año 1: Periodo más antiguo,Año 3: Periodo más reciente
Number of Days

Year 1 Year 2 Year 3

Years

Year 1 Year 2 Year 3

Current Asset

Year 1 Year 2 Year 3

Non-Current Asset

Year 1 Year 2 Year 3

• TotalActivo

Year 1 Year 2 Year 3

•Pasivo Corriente

Year 1 Year 2 Year 3

Non-Current Liabilities

Year 1 Year 2 Year 3

• Total Pasivo

Year 1 Year 2 Year 3

Heritage

Year 1 Year 2 Year 3

Sales

Year 1 Year 2 Year 3

CostofSales

Year 1 Year 2 Year 3

Usefulness

Year 1 Year 2 Year 3

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Net Income of the Period

Year 1 Year 2 Year 3

AccountsReceivable

Year 1 Year 2 Year 3

AccountsPayable

Year 1 Year 2 Year 3

SocialCapital

Year 1 Year 2 Year 3

Stocks

Year 1 Year 2 Year 3

14. Did the company submit the last 3 financial statements (Balance Sheet and Income Statement)?
signed by the accountant or audited?

15. Sales Volume

InTotalSector,registerthesalesofthesectortowhichyourclientbelongs(client'ssector:mining,
industry, fishing, beverages, construction, etc.) by period (year 1, 2, and 3).
InTotalSales,[Link]
casesmustbeexpressedinthesamecurrencies.
Unscored question.
Year1

Period (day/month/year) Total Sector TotalVentas Total Sector / Total Sales

Year2

Period (day/month/year) Total Sector TotalVentas Total Sector / Total Sales

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Year3

Period (day/month/year) Total Sector TotalVentas Total Sector / Total Sales

FINANCIAL OBLIGATIONS AND BANKS

16. Is the company up to date with its short and long-term bank obligation payments? (overdrafts,
negotiable obligations, leasing, promissory notes) Detail:
(1) Monto:Indicar elvalor y monto.
(2) Indicate the exchange rate and date.
(3) Registered by SGS: YES or NO.
ListofBankingObligations

Tipo de Obligación Amount (USD or S/.) Exchange rate and date (2) is up to date in the
(In effect) payments(3)

[Link]:
Doesthecompanyrecordoverdueandunpaidobligations?
(Report date - registered by SGS).
Inverse scoring, the 'NO' gives the score in favor.

18. Does the company have any administrative and/or judicial processes against it?
Inverse scoring, the "NO" gives the score in favor.

19. Detail the banks that the company works with (Question without score)
ListofBanks

Bank Branch Number of Telephone Sectorist

Count

20. The qualification by the financial entities that is recorded in the Superintendency of
Does the Bank and Insurance (SBS) consider the company as normal?

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INSURANCE

Doesthecompanyhavethefolowinginsurancepolicy?
Third Party Damage Insurance / Liability Insurance
21. Type of policy / Insurance Policy number and InsuranceCompany Current policy
validity

•Indicateanotherpolicy(ifapplicable)

22. Type of policy / Insurance Policy number and InsuranceCompany Active policy
validity

Supplementary Work Risk Insurance Policy (SCTR)

23. Tipo de póliza /Seguro Policy number and InsuranceCompany Active policy
validity

COMPLIANCE WITH LEGAL OBLIGATIONS

Inthelast6months,didthecompanysubmitthedeclarationandpaymenttoSUNAT,accordingtotheschedule?
monthly obligations?
SUNAT - VAT

25.Inthelast6months,didthecompanysubmitthedeclarationandpaymenttoESSALUDontime,accordingtotheschedule?
monthly obligations of SUNAT? (When applicable)
ESSALUD-PLAME

26.Inthelast6months,didthecompanysubmitthedeclarationandtimelypaymenttoAFP/ONP?(Whenapplicable)
applicable
•AFP/ONP

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OPERATING CAPACITY

COMPANY FACILITIES

Silaisnstalationasreownre,gistethredatainthefolowingtable:
Offices
27. Area (m2) / Own Mortgaged / Own Antiquity (years) Formal property
Own

Warehouseofsupplies/rawmaterials
28. Área(m2) / Propio Hipotecado / Propio Antigüedad (años) / Formal property
Own

Sparepartswarehouse
29. Area (m2) / Own Mortgaged / Own Antiquity (years) / Formal property
Own

Workshop
30. Area (m2) / Own Mortgaged / Own Antigüedad (años) / Formal property
Own

Others
31. Area (m2) / Own Hipotecado / Propio Antigüedad (años) / Formal property
Own

Silaisnstalationasrerentedre,gistethreinformationinthefolowingtable:
Offices
32. Area (m2) / Rented Rental Validity Formal rental

Warehouseofsupplies/rawmaterials
33. Area(m2) /Rented RentalValidity Formal rental

Sparepartswarehouse
34. Área(m2) /Alquilado RentalValidity Formal rental

Workshop
35. Área(m2) /Alquilado VigenciadeAlquiler Formal rental

Others
36. Area (m2) / Rented RentalValidity Formal rental

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Register the information of the facilities (owned or rented) that you have:
Offices
37. Address City State

Warehouseofsupplies/rawmaterials
38. Address City State

Sparepartswarehouse
39. Address City State

Workshop
40. Address City State

Others
41. Address City State

42. Does the company have warehouses under special conditions, and is there a record of the control of these?
required conditions to prevent deterioration? For example: Warehouse with temperature/humidity control/
hazardous substances/ etc.

[Link]
Shifts and working hours

Administrative Workshop Warehouse Works / Others

a Service

PRODUCTION MANAGEMENT

44. Indicate the sales volume of the product line of the evaluated activity. Report in the same unit.
(hours/man,others)andperiod(monthoryear).
Question without score.
Capacitylist

Evaluated activity Installed capacity (1) Current Service (2) Capacidad Ocupada % (3)

45. Description of each process participating in the evaluated activity (Question without score):

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COMMUNICATION SYSTEMS

Does the company have a phone / mobile phone?

[Link]/Intranetnetwork(06PCs)?

48. Does the company have a WAN/Extranet network?

49. Does the company have a fixed internet connection/email?

EQUIPMENT AND TRANSPORT UNITS

50.Registerthe10mainmachinesandequipmentthatparticipateintheevaluatedactivity:

Brand Description CapacityYear of Ownership or

Acquisition rental
formal

51. Does it have measurement equipment and instruments used for the evaluated activity?

Registrar:

Description Brand Last date of

calibration

52. Detail the own or subcontracted transport units with which the company has and that participate in
the assessed activity:

Brand Description Capacity Type Year of Plate Property or

Manufacturing alquiler
formal

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HARDWARE, SOFTWARE, AND SPECIALIZED EQUIPMENT

53. Do you have computers and specialized software used for the development of the activity?
evaluated?

54. Do the software used in the evaluated activity have licenses?

Registrar

General use software / Validity

Management software

55. Does the company perform periodic backups and does this include information related to the
evaluated activity?

PERSONAL

[Link](payroll)andSubcontracted(receiptforfees).
Scoreless question.
Fixed

Subcontracted

[Link] antigüedad delos trabajadores (años).

Question without score.
FIXED

SUBCONTRACTED

CLIENTS

58. Detail the main clients corresponding to the last three years and that are related to
evaluated activity.
Question without score.

BusinessName Activity sector of Contact Antigüedad (años)

client

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QUALITY MANAGEMENT

QUALITY MANAGEMENT SYSTEM

59. Does the company have a certified Quality Management System, and is the certification scope included?
evaluated activity?

Silaempresa has a certified Quality Management System, please indicate the scope.
validity and certifying entity:

60. Has the company defined the Mission and Vision of the organization?

61. Does the company have a stated quality policy approved by senior management?

62. Does the company disseminate the Quality Management Policy and Objectives to the staff?

63. Do you have a procedure implemented to control the review, approval, change control, and
identification of your documents and records?

64. Have they defined relevant quality management objectives aligned with the needs of the company?

65. Has the company defined and implemented measurable quality management indicators for the organization?
allowing to monitor the compliance with the established objectives?

66. Has the company appointed a management representative to ensure that it has been established and
maintaintheQualityManagementSystem?

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67. Are management reviews of the management system conducted periodically by management, generating them
corresponding records?

68. Have the specifications of the offered products been defined?

69. When any material or property of the client is temporarily located in the facilities of the
company,thismaterialisfullyidentifiedandthenecessaryprecautionsaretakentoavoidits
deterioration

70. Does the company have a written and implemented procedure for controlling non-conforming services?

Does the company have a written and implemented procedure for generating corrective actions?
preventive actions?

72. Does the company have a written and implemented procedure for conducting internal audits, the same
What does it include, internal audit records and results?

73. Have you had internal or external audits to verify the efficiency of the Quality Management System, and
Doesthescopeincludetheevaluatedactivity?

Personnel Management

74. Does the company have defined job profiles that take into account education, training,
skills and experience for the different positions of the organization?

75. Do you have a systematic procedure for recruitment and selection of personnel? In case of a response
bepositive,presenttherecordsthatverifythisevaluation.

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76. Does the company have a document that defines the functions of the positions related to the
evaluated activity?

77. Has the company implemented a training program for staff, based on the needs of
detected training?

78. Does the implemented training program include topics related to the evaluated activity?

79. Does the company maintain personnel files that support what is indicated in the job profile (education,
training and experience)?

MAINTENANCE AND CALIBRATION

80. Does the company have records of the corrective maintenance of equipment, machinery, and units?
vehicles involved in the evaluated activity?

81. Has the company implemented a preventive maintenance program for equipment, machinery and
Vehicle units that are used in the evaluated activity?

82. Do you have a defined and implemented calibration program for the measuring instruments involved?
inthevaluatedactivity?

83. Are the measuring devices identified with labels indicating when they were calibrated and
Whenisyournextcalibration?

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QUALITY MANAGEMENT

QUALITY MANAGEMENT SYSTEM

59. Does the company have a certified Quality Management System, and is the certification scope included?
evaluated activity?

Silaempresa has a certified Quality Management System, please indicate the scope.
validity and certifying entity:

60. Has the company defined the Mission and Vision of the organization?

61. Does the company have a stated quality policy approved by senior management?

62. Does the company disseminate the Quality Management Policy and Objectives to the staff?

63. Do you have a procedure implemented to control the review, approval, change control, and
identification of your documents and records?

64. Have they defined relevant quality management objectives aligned with the needs of the company?

65. Has the company defined and implemented measurable quality management indicators for the organization?
allowing to monitor the compliance with the established objectives?

66. Has the company appointed a management representative to ensure that it has been established and
maintaintheQualityManagementSystem?

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92. Does the warehouse have the safety data sheets for the stored chemical products when these
Do they represent any type of risk to health or the environment? Includes warehouses under conditions
special (as applicable).

93. Does the company have records of the periodic inventories conducted in the warehouse? Includes warehouses
under special conditions (as applicable).

SUBCONTRACTED PROCESSES

In cases where the organization chooses to outsource any process that may affect it
Service conformity. Is there a control of the subcontracted processes?

PRODUCTIONPROCESS(SERVICE)

[Link],[Link].
and validating that the result meets the previously defined requirements?

96. Does the company have its own planning and scheduling system for its works and services?

[Link],dotheyuseanysoftwareorcomputermediumforthis?
Planning and programming activity of your works/services?

98. Do you have written specifications of the services provided to the customer, identified as current and
available in the relevant places?

99. Does the company provide its services based on a national or international standard?

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100. Do you have the documentation of the national or international standards used in the service provided?

101. Do you have a systematic procedure in place to carry out quality control during the process of
execution of the service/work? Including, if applicable, sampling plans, inspection criteria, etc.

102. Was a service order worked on during its execution?

103. Do you have documents that allow for traceability / monitoring / tracking of the service provided?

104. Do you have a systematic procedure in place to carry out quality control of the service provided,
oncecompleted?Including,ifapplicable,testprotocols,visualinspection,etc.

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SECURITY, HEALTH AND ENVIRONMENT

Safety and Occupational Health

105. Does the company have a stated Occupational Health and Safety Policy approved by senior management?
anddisseminatedtothestaff?

106. Does the company have an Internal Regulation on Occupational Health and Safety, updated and distributed to
allstaff?
Applicable to companies with more than 20 workers.

107. Does the company have a Health and Safety Committee?

Applicable for companies with more than 20 workers.

108. Does the company have a Health and Safety Supervisor with studies in safety and
experience in the evaluated activity?

109. Has the company implemented the Annual Health and Safety Program?

110. Does the company have records of the identification of hazards and risk assessment (IPERC matrix)?
whichincludestheprocessesrelatedtotheevaluatedactivity,theworkarea,andinstallations?

111. Have they defined a list of dangerous tasks whose risk needs to be controlled?

112. Have the risks of occupational diseases that personnel may suffer been defined?

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113. Do you have the procedure for handling chemicals/inflammables implemented?

114. Do you have the security and health procedure for high-risk jobs implemented? For example: work
ahteighct,onfinedspacese,tc.

115. Do they have the procedure implemented for the operation of vehicles / cranes / forklifts and others that
participate in the evaluated activity?

116. Does the company conduct periodic internal security inspections in the different areas of the organization?
(warehouse, administrative, patio, vehicle units, among others)?

117. Does the company have an adequate occupational health and safety training program implemented to...
organization and nature of the evaluated activity?

118. Has the company implemented an incident/accident investigation procedure?

119. Does the company have fire extinguishers with valid charges in the different areas (such as warehouses,
operational part (service/work) and administrative offices)?

120. Does the company provide its workers with personal protective equipment according to the evaluated activity?

121. Do the company's areas have signage, restricted access to risk areas, and safe zones?

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122. Does the company have first aid kits in the different areas, which are equipped with their
respective list of products (items)?

123. Does the company have an annual drill program, is it being fulfilled?
P r e s e n t a r e p o r t o f t h e d r i l l c o r r e s p o n d i n g t o t h e l a s t y e a r.

Environmental Management

124. Has the company established an Environmental Policy, approved by senior management and disseminated to staff?

125. Has the organization defined a methodology for identifying environmental aspects and evaluating
impacts?

126. Have the environmental aspects been identified and their impacts evaluated?

127. Has the organization defined and implemented Operational Controls for environmental aspects?
significant and have the corresponding documented procedures?

128. Have you defined an Environmental Emergency Plan?

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COMMERCIAL MANAGEMENT

Commercial Management

129. Prior to the sale, the company evaluates whether it is able to meet the requirements of
client (in terms of quality, quantity and delivery time), providing them with a quote / proforma

130. Before carrying out the sale, the company assesses whether it is in a position to meet the requirements of the
client (in terms of quality, quantity, and delivery time), providing them with a technical proposal

131. Prior to the completion of the sale, the company evaluates whether it is in a position to meet the requirements of
client (in terms of quality, quantity, and delivery time). Indicate what other document:

132. Does the company evaluate customer satisfaction by keeping records of this activity?
Surveys.

Does the company take actions based on the results of the satisfaction evaluation conducted?

Do you have a systematic procedure in place for addressing complaints or observations from
clients?

Does the company record the complaints/observations of the clients and generate statistics from them?

136. Is it possible to know the delivery time and verify compliance with it after delivering the product?

137. Do you have a systematic work procedure in place to address delays in product delivery?

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[Link].
evaluated: (registered by SGS)
The justification will be valid when the delay in the delivery of the product is the customer's responsibility.

Item Orderof Dateof Realdate Days of Justified Reason

purchase delivery of delivery delay
agreed

139. Do the services provided by the company have a warranty period established?

140. Does the company provide any type of technical support to its clients?

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